The Outsiders

[drk]

The "outside prescription" folks.

Hey, in an independent optical, that's the reason you exist. You have a system, and it works. You spend all the time in the world with them. You take their history, you qualify them, you look at their old glasses. And you probably don't take VSPee or EyeRed.

But I'm in a different venue, and some of you opticians work in optometry practices (or even ophthalmology practices).

(Let's digress to discuss ophthalmology practices with opticals. If they aren't for sheer in-house patient Rx filling, I'd be double-shocked. Who is going to walk in off the street to fill another OMD's Rx in an OMD office? I'd be surprised it ever happens.)

But optometry practices are the middle case.

Our opticals are generally devised to provide in-house service to our patients, but ODs tend to be more accessible in storefront-type or freestanding buildings (guilty!) with pictures of an interesting model with orange hair and green glasses hanging in the front window. Yes, we ask for it in many ways (guilty).

But we are also VCP w.h.o.r.e.s. Don't forget that fact.

So, how do we feel when a patient walks in/dodders in with an outside Rx in hand?
a. Thrilled! Can't wait to help.
b. Just part of the job, even if it is a bit chaotic.
c. Filled with dread. Here comes trouble!


If the walk-in is a fashion-conscious 40-year-old lady with a nice purse and is private pay, and we're not slaving over our morning schedule, we might feel like "a".
If the walk-in is a wife with husband in tow and they want to use their VCP, the answer might be "b".
If the walk-in is an 85 year-old walker-driving widow with her daughter in law holding open the door, with an outside Rx after cataract surgery that reads "OD plano / OS +4.00-2.00x028 +3.00 add", and they're here because she has a Medicare Advantage plan and we're providers for her EyeMed and we're busy with our scheduled patients, we definitely feel like "c".


So how does your office handle this?
How do outside Rxs fit in your optical?

[dwlk]

used to work as a solo optician in a strip mall, so got super good at the whole scheduled/walk-in multitask dance, but most pt's who walk in here are generally very kind and understanding and dont mind waiting or window shopping the frame selcetion

[DanLiv]

So how does your office handle this?

I am in a small 1.5 doctor Optometry practice. We don't have storefront so our walk-in traffic is minimal, but of course we get outside Rxs. First, as you said, our business model revolves around catering to our exam patients and existing eyewear customers, and if we're doing things right everyone is booked and busy every day. My opticians and I are professionals and are scheduled like my doctors are, with dispenses, expected glasses selections for the day's exams, and walk-ins. My front desk is excellent at dealing with walk-ins, makes clear that our opticians see customers by appointment, and offers to appoint them with an optician at a later time or day. If my schedule is full it means I have dedicated my time to current customers, and I will not sacrifice their experience, the walk-in's potential experience, or my own sanity to wedge someone in to a well-planned day. If they come back at an appointed time I will reserve it just for them, like I did the customers I didn't compromise when they walked in.

Our industry does have an identity crisis between healthcare and retail, and in the public eye we are lumped into the same category as retail opticals that do operate on a primarily walk-in bases. But we are healthcare professionals and we need only accept the retail model if we choose to.

How do outside Rxs fit in your optical?

I'm interested to put this here, because I imagine mine will not be a popular opinion. Our rx change redo policy is stated and applies to our own prescribers rx's only. Outside rx's do not get a "free redo" for rx change. I recommend to all outside rx's that they get a refraction from our doctors (a "second opinion") and fill that instead, in which case we guarantee it with our rx change policy. If they decline I will fill as requested, but there is no rx change concession. Most accept my recommendation and schedule for a refraction only (or just leave, which is ok. That non-compliance with best practices indicated future headaches anyway), and of those half the time we get a comforting confirmation of the outside rx, but half the time we have a difference of opinion, which is exactly the point of our policy. There are too many lousy prescribers out there for us to shoulder the chore of redoing their shoddy work, when we know we have responsible prescribers within our own walls. If you want to gamble, go ahead, but you're gambling with your money, not ours.

[Kwill212]

I'm interested to put this here, because I imagine mine will not be a popular opinion. Our rx change redo policy is stated and applies to our own prescribers rx's only. Outside rx's do not get a "free redo" for rx change. I recommend to all outside rx's that they get a refraction from our doctors (a "second opinion") and fill that instead, in which case we guarantee it with our rx change policy. If they decline I will fill as requested, but there is no rx change concession. Most accept my recommendation and schedule for a refraction only (or just leave, which is ok. That non-compliance with best practices indicated future headaches anyway), and of those half the time we get a comforting confirmation of the outside rx, but half the time we have a difference of opinion, which is exactly the point of our policy. There are too many lousy prescribers out there for us to shoulder the chore of redoing their shoddy work, when we know we have responsible prescribers within our own walls. If you want to gamble, go ahead, but you're gambling with your money, not ours.

This is exactly how it should be, and pretty much how I do it. I'm not fixing other people's mistakes for free. There are a select few nearby clinics who I will straight up refuse to fill Rxs from. There are another half a dozen that I will trial frame and auto refract before filling, or refering to my OD to fix.

[drk]

Denver is a big town, and it would be difficult to vet outside Rxs based on prescriber name only. I don't know how to handle the outside Rxs other than a case-by-case basis.

So we decided to formalize a policy similar to yours:

1. Walk ins are greeted and told that our optician works by appointment, and we are happy to schedule one.
2. At that point, we get all the demographic information that we would on any new patient encounter, including VCP information and hopefully the spRx to scan into the record.
3. If patient wants to browse (as a condition of, or after scheduling) we don't disallow it (but then we have to keep an eye on them...theft of merchandise/theft of service/showrooming. We're tied up so that isn't preferable...if it were in the mall we'd have everything under glass...).
4. If they want to "write something down" we'll put it in their record for later.
5. We prefer to preview the situation before they come in...is their plan decent or crap? Is the Rx a sad joke? Is the patient a potential problem, per the first interaction ("Oh, my last eye place could never get it right", yadda yadda.) If it looks like a total loser, we can find a way to balk and not take the patient. Nobody says we have to. (Except probably the VCP contract, but...)

This is the best I can come up with.

[optical24/7]

All I can say is wow! There’s at least 3 here, as a consumer, I would walk out on with your attitude and policies. I never worked like that in 50 years of optics. My last gig was running 3 locations, OMD owned, and yes, tons of walk in’s. My main location I ran and personally practiced in was in a high traffic upper end medical complex ( 3, 6 story buildings full of specialists).

Approximately 46% of my business was walk in, no appointment, no referral. We had an inviting front and windows, we were upbeat and happy to see every person who came in (other than the nut cases we already knew about). I had more “tough” cases referred than cold walk in’s. ( actually less problem Rx’s from walk in’s). We took zero VCPs, we would give an “ out of network “ discount and fill an out of network form for those who had a VCP, give them an addressed and stamped envelope with detailed receipt. They payed us up front and they submitted for reimbursement themselves. We “captured” most that had a VCP too. ( It’s all in how you present yourself and product).

I got the same discount from labs on remakes for my “in house” patients as walk in’s. If I got a wonky Rx it gave me a chance to convert them to our practice with our doctors.

I learned long ago that you catch more flies with honey than you do with vinegar. From the time I came to this practice, that was around for 25 years, single location with 3 docs, we grew to a 3 location, 7 Dr operation off the back of the opticals in 5 years. The key was twofold; great retail locations for the opticals, coupled with interaction with new patients that didn’t know our doctors from squat. But hey, what do I know, you guys seem happy with where you’re at, and I commend anyone who’s happy with their business.

[drk]

"great retail locations for the opticals"
"tons of walk in’s"
"We took zero VCPs"

It sounds like a great set up. You were geared for that kind of practice, and that's great.

Can you tell us a little about how you staffed the opticals? Was there a little excess capacity available to "flex" when you needed help on the "floor"?

[optical24/7]

It all starts with the employees you hire. I always tried to create a great work environment. Keep it fun, uplifting. Everyone got time off every week, paid, just for how “awesome” they were at work. Nobody worked 40, but got paid for it. Tapped into their natural competitive spirit, I didn’t need contests for prizes. Everyone had a common goal, and enjoyed the journey! I rewarded loyalty and took the bullet aimed at them. I created a place all Opticians would want to work, so I got to be picky on hiring…It payed off.

If you create a great work environment, you can attract the cream of the crop in your employment needs. I can proudly say, I only lost a very small handful of employees over the years. Mostly for spouse moving or just getting out of optics. Employees are the backbone of any company. You want the best? Then you’re gonna have to treat them as the best if you want to attract and retain them.

As far as staffing, us 4 were very good at multi tasking. If we were extremely busy, we could delegate, (we encouraged browsing!) and even excuse ourselves, hand off a patient even at times (not normal). We never made appointments, come on in! It may be an hour till I can fix your frame, but you can come back or wait. You weren’t denied and told to bring your problems to me later… Honey tastes better than vinegar..

[iD]

It all starts with the employees you hire. I always tried to create a great work environment. Keep it fun, uplifting. Everyone got time off every week, paid, just for how “awesome” they were at work. Nobody worked 40, but got paid for it. Tapped into their natural competitive spirit, I didn’t need contests for prizes. Everyone had a common goal, and enjoyed the journey! I rewarded loyalty and took the bullet aimed at them. I created a place all Opticians would want to work, so I got to be picky on hiring…It payed off.

If you create a great work environment, you can attract the cream of the crop in your employment needs. I can proudly say, I only lost a very small handful of employees over the years. Mostly for spouse moving or just getting out of optics. Employees are the backbone of any company. You want the best? Then you’re gonna have to treat them as the best if you want to attract and retain them.

As far as staffing, us 4 were very good at multi tasking. If we were extremely busy, we could delegate, (we encouraged browsing!) and even excuse ourselves, hand off a patient even at times (not normal). We never made appointments, come on in! It may be an hour till I can fix your frame, but you can come back or wait. You weren’t denied and told to bring your problems to me later… Honey tastes better than vinegar..

are you hiring? lol

so let me tell you a story about the opposite of this. One optician and one optician assistant (helps people select eyewear, lenses, minor adjustments and bill). There used to be a monthly goal you'd need to hit but that stopped since late last year. Owners never explained why just that they'll get back to us about it. It wasn't much but it helped. Owners tried to shorten lunch from one hour to thirty minutes and I believe everyone was ready to quit if that was the case. Then they tried to start half an hour early and still keep us until late. We tried to see double the patients at twenty minute intervals instead of 30-45 minutes. Then try to open Saturday for a while. Certain patients are getting priority over other ones depending on what they spend. No dilation ever, not even diabetic patients. Morale is so low you can touch the Earth's core. I don't see this office surviving much longer well at least with the amount of care and joy that it once had. *end rant*

[optical24/7]

are you hiring? lol

………

^ This is what I always strived for. Folks wanting to work with us. Word of mouth gets out through reps and peers that you have a great work environment. The one thing that always gets me is when you see an ad for optical employment….” Competitive pay”….? Are you looking for a seat polisher or a valued colleague that will contribute towards your goals? You need to offer “above competitive pay”, if you want real talent. I don’t care how great you are, unless you’re a Lone Ranger location, your employees are critical to your success.

[Elvis Is Alive]

I'm similar to 24/7. I've been in optical industry 30 years. I've never scheduled a dispense or turned away a walk-in in all that time.

I've worked corporate, 4 MD practice, large doctor-owned multi location MD and OD practice, and currently a private OD practice where myself and the Dr's spouse are the only employees. I've worked corporate management managing over 30 employees, ran a one person optical shop as well.

It's always been honey over vinegar for me. I've offered them to come back or wait if we are busy, and 99% of the time they are ok with this. Speaking with them in a timely and friendly manner goes a long way.

[NAICITPO]

I'm similar to 24/7. I've been in optical industry 30 years. I've never scheduled a dispense or turned away a walk-in in all that time.

I've worked corporate, 4 MD practice, large doctor-owned multi location MD and OD practice, and currently a private OD practice where myself and the Dr's spouse are the only employees. I've worked corporate management managing over 30 employees, ran a one person optical shop as well.

It's always been honey over vinegar for me. I've offered them to come back or wait if we are busy, and 99% of the time they are ok with this. Speaking with them in a timely and friendly manner goes a long way.

This has been my approach too, though I don't have 30 years in the industry just 15. Worked for the evil empire and now I work in a multi-location private practice. I have definitely taken a similar approach from big box to private practice. Everyone gets helped but I am not superman. They are welcome to wait. My favorite thing is when we get multiple customers shopping at once and they start helping each other. Create some camaraderie and a fun environment, it also allows me to bounce around the room and steer multiple people in the right direction. I'm here for the chaos it is what I have always done, would feel foreign to do it some other way. I'm sure you probably feel the same way about your approach @Dan Liv.

[CME4SPECS]

I am an independent optician, I have an optical store, not a clinic or office type setting. When the door swings open at 10am, everyone is welcome, no appointment necessary. Every rx that I get is from the "outside." I will redo a new rx 1 time at no charge. If the rx has been sitting in your purse for a year, that's a different story. I don't have many redo's, so it's really not a problem. I do not accept insurance, I pity all of you that deal with all of that!

[AndyOptom]

Local context here (Malaysia, Southeast Asia), is usually that walk in patients are always welcomed. Of course, if someone else is already occupying all available staff, they are often politely told to have a seat to wait, and/or to browse the frames first.

Regarding filling of outside Rx, also quite common here, since ophthalmologists hardly have an attached optical dispensary. I do insist on trial framing the Rx first to verify acuities, and have declined dispenses when the patient refuses this: my reasoning for them being that doctors are human too, mistakes happen.

If the old Rx is available for comparison, I do give them a heads up on any changes I might expect them to encounter due to possible Rx changes.

All that said and done, my colleagues and I generally wouldn't entertain disputes that we filled an outside Rx wrongly if the product and prescription are measurably correct.

[KrystleClear]

The "outside prescription" folks.

(Let's digress to discuss ophthalmology practices with opticals. If they aren't for sheer in-house patient Rx filling, I'd be double-shocked. Who is going to walk in off the street to fill another OMD's Rx in an OMD office? I'd be surprised it ever happens.)

Well, I'm ophthalmology and while yes, we mainly just deal with our own patients, I do get outside RXs and fill them. I am not sure why they come to us and not the prescribing doctor because we don't take any insurances now, outside of billing Medicare plans after cataract surgery for their first pair of glasses. I actually would love if my office spent more of the marketing budget on promoting the optical and I got more outside people coming in. Granted, having the "we don't take vision insurance" conversation over and over does get old, but the big box opticals are charging astronomical out of pockets on top of the vision plan coverage, so we are still competitive unless the person is a bare bones "only what's covered" type. And we are seeing more and more people come to us after a disappointing experience with the big box opticals.

Some days I am really busy but a lot of days I'm not. If it's a day where my doctor just isn't printing scripts, it's a ghost town over here. So if an outside rx walks in, I am happy for the business. Now, if and when we run into RX issues, we do send them back to the prescribing doctor or we can do our own RX check but it wouldn't be no charge. Our lab offers remakes due to doctor's RX changes so it's not the end of the world.

I actually just had a patient walk out with her RX from my doctor because we don't take her vision plan. I explained that I can happy supply her with the needed itemized receipts to submit to her vision plan for reimbursement but she wasn't having it. Her RX was one where my doc wanted a multifocal lens with NO ground in prism but instead a 9BO fresnel on the right eye, as her symptoms are expected to resolve eventually. I bet the people at MyEyeDr will be feeling "c". Will they understand that script with plus cyl and fill it correctly? Will they ignore the Fresnel note and just grind 9 BO in the right eye? Do they know how to place a Fresnel prism? I suspect she will be back to see me. Not to disparage big box opticians, but when I was one, I never even saw a Fresnel sticker let alone knew what to do with it.

[Elvis Is Alive]

I used to be in that exact type of practice Krystal. 4 MD practice only filing post-cataract Medicare claims. It was located in a multi-practice, multistory building so I saw very few walk-ins. You had to want to go there. We did about 60% pts from the MDs and 35% employees of the multi-practice clinic who received a self-funded vision benefit.


I didn't have to deal with VCPs for the 10 years I was there. Glad I don't have to deal with them anymore as well.

[Elvis Is Alive]

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